Infection Prevention and Control Measures for Occupational Health Management for all Health Care Settings - Public Health Agency of Canada

Guidance: Infection Prevention and Control Measures for Occupational Health Management for all Health Care Settings
Human Cases of Pandemic (H1N1) 2009 Flu Virus
Posted: 2009-12-15

This guidance document has been developed to provide guidance for the occupational health (OH) and infection prevention and control (IPC) management of health care workers1 (HCWs) and other staff to prevent the transmission of Pandemic (H1N1) 2009 Flu Virus in all settings where health care is provided. While it is expected that this document will provide helpful information to all HCWs, its primary audience is those individuals who are responsible for IPC and OH in all settings where health care is delivered. This guidance will cover prevention strategies, occupational exposures, post-exposure management and treatment of ill HCWs as well as recommend definitions of fitness-for-work.

This guidance document is being provided by the Public Health Agency of Canada (PHAC) in response to the Pandemic (H1N1) 2009 Flu Virus outbreak. This guidance is based on current, available scientific evidence about this emerging disease, and is subject to review and change as new information becomes available. The following guidance should be read in conjunction with relevant provincial and territorial guidance documents and existing federal/provincial/territorial legislations and regulations. PHAC will be posting regular updates and related documents at www.phac-aspc.gc.ca. The content of this document has been informed by discussion with and technical advice provided by the Infection Control Expert Advisory Group to PHAC.

An effective Occupational Health (OH) program is the basis for an effective response during an influenza pandemic. It is recommended that every healthcare organization have an occupational health and hygiene program2 that is prepared to implement measures identified in the pandemic plan, including prevention, post-exposure management and appropriate treatment of HCWs with suspect, probable and confirmed Pandemic (H1N1) 2009 Flu Virus. An effective OH infectious disease program will include a hierarchy of system and personal control measures, (i.e., engineering and administrative controls, vaccines and use of personal protective equipment) to assist employers and enable employees of healthcare organizations to perform their duties in an environment that minimizes their risk of exposure to hazards, including infectious agents.

The clinical picture to date in Canada, of human illness from Pandemic (H1N1) 2009 Flu Virus is one of mild disease for most individuals, however, some individuals will experience moderate or severe disease. At this time, the epidemiologic data from PHAC suggests that the incubation period for H1N1 2009 is on average 4 days and untreated individuals may remain infectious for up to 7 days, or longer if severely ill or immunocompromised. With the exception of a few case reports of resistance to oseltamivir, Pandemic (H1N1) 2009 Flu Virus is susceptible to the antiviral agents oseltamivir and zanamivir, which represent therapeutic options. Full application of PHAC’s infection prevention and control guidelines, Routine Practices and Additional Precautions, including Pandemic Influenza Precautions measures will minimize or prevent the transmission of all infection, including pandemic influenza in settings where health care is provided.

Spread of Pandemic (H1N1) 2009 Flu Virus has been almost exclusively in the community setting to this point, and this is where most exposures for the general public and health care workers alike will likely occur. When HCWs and other staff are in the larger community (e.g. out shopping, attending public gatherings) they will share the same risk of acquiring influenza as the general population.

This guidance may require modification as the clinical and epidemiological picture changes.

For occupational health management, the following criteria for influenza-like-illness (ILI) can be used to determine the need for applying the occupational health and infection prevention and control measures found in this guidance:

Acute onset of respiratory illness with cough and/or fever*
And 1 or more of: sore throat, headache, arthralgia, myalgia, or prostration (refer to Appendix A)
*Although surveillance criteria specify fever and cough, fever is not always present with Pandemic (H1N1) 2009 Flu Virus infection. The recommended criteria in this guidance document are more stringent than PHAC surveillance criteria, in order to minimize the risk of introducing influenza into the healthcare setting by an infected HCW or other staff member.

This guidance document is to be used in conjunction with other existing H1N1 guidance documents.

The following are occupational health and infection prevention and control measures for Pandemic (H1N1) 2009 Flu Virus.

Organizational Occupational Health Planning
Education
Influenza Immunization
HCW and Staff Self-assessment
Hand Hygiene
Respiratory Hygiene (also known as Respiratory Cough Etiquette)
Fitness-for-work specific to Pandemic (H1N1) 2009 Flu Virus
Definition of Occupational Exposure specific to Pandemic (H1N1) 2009 Flu Virus
Antiviral Treatment specific to Pandemic (H1N1) 2009 Flu Virus
Reporting

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Infection Prevention and Control Measures for Occupational Health Management for all Health Care Settings - Public Health Agency of Canada